Celebrating the EMS 1%’ers: The Expert Reviewers Behind The G&A Way!
In emergency medicine, excellence isn’t optional—it’s essential. Nowhere is that more evident than in the elite ranks of EMS documentation professionals known as the EMS 1%’ers at Girard & Associates, Inc. Our expert reviewers represent the top tier of prehospital clinical and documentation expertise. They are not only experienced paramedics with an average of 19 years of 911 patient care documentation experience—they are educators, mentors, and critical thinkers trained to protect patients and providers alike through expert chart review.
These reviewers represent the top tier of prehospital clinical and documentation expertise. They are not only experienced paramedics and EMTs with an average of 19 years of 911 patient care documentation experience—they are educators, mentors, and critical thinkers trained to protect patients and providers alike through expert chart review.
And it all starts with a good audit.
More Than Compliance: The Art of the EMS Audit
To many agencies, chart review is a compliance task. To Girard & Associates, it’s a clinical craft. The review of an EMS patient care report (PCR) is not just about identifying what went wrong—it’s about asking what could have been done better.
A quality EMS audit does more than catch errors—it prevents future ones.
Take, for example, a case where a provider correctly identifies a stroke and activates a stroke alert. A routine CQI review might stop there. But a G&A 1%’er digs deeper. Was a complete neuro exam done? Was a 12-lead obtained? Was a thorough differential considered?
If not, that’s an opportunity—not for punishment, but for improvement.
“At Girard & Associates, we believe CQI shouldn’t just be about reacting to mistakes,” says Paul Girard, Founder and CEO. “It’s about catching gaps before they become problems. Our reviewers are trained to identify improvement opportunities proactively, not just correct when it’s too late.”
Becoming an EMS 1%’er: A Standard of Excellence
To even be considered for the EMS 1%’er team, reviewers must meet rigorous qualifications:
- Minimum 5 years of 911 patient care documentation experience
- Demonstrated mastery of state treatment protocols
- Proven ability to analyze complex clinical cases and documentation
- Submission and evaluation of diverse sample PCR reviews
- Successful completion of a 16-hour EMS CQI ePCR Review Training Program
- Participation in mentored case reviews with a senior reviewer
But even more important than credentials is mindset. The best auditors aren’t just rule-followers. They’re clinicians with a passion for teaching, a relentless eye for detail, and a commitment to better outcomes—not just better paperwork.
Uncovering What Others Miss
Many EMS CQI programs are forced to prioritize major clinical errors due to time and staffing constraints. But that leaves a dangerous blind spot. Seemingly “minor” documentation gaps—like an incomplete exam, an undocumented intervention, or an unclear clinical rationale—can snowball into missed diagnoses, delayed care, or even litigation.
One of the most common comments Girard & Associates hears from providers during feedback sessions?
“No one ever told me this before.”
That’s the danger of superficial review. Providers can’t fix what they don’t know is broken. Without real feedback, even well-meaning clinicians may repeat the same subtle documentation or assessment errors for years—until a bad outcome exposes them.
That’s why every G&A audit is thorough, structured, and risk-scored, using proprietary tools that drive both feedback and improvement.
Our auditors are trained to read between the lines of the PCR. They look for things other audits miss. Did the provider extricate the patient before assessing and starting care on scene? Is the patient refusal high risks necessitating the need for online medical control? Did the provider consider all potential differential diagnoses? Would this call pass muster from a medical/legal review?
From Audit to Action: Helping Providers Get Better
Each G&A review is part of a larger feedback loop. Once a chart is reviewed and scored, high-risk calls and trends are shared with the agency’s medical director and routed to a trained EMS CQI Coordinator.
These coordinators conduct one-on-one coaching sessions with providers using The G&A Way methodology and the 4C’s of Successful EMS CQI Leaders:
- Command Presence – Confidence backed by knowledge
- Competitiveness – A drive to improve
- Coachable – Willingness to grow
- Compassion – Commitment to patient care and peer support
Every provider receives individualized coaching designed to improve their thinking, documentation, and clinical delivery—not just their charts.
Raising the Bar in EMS, One Report at a Time
Being an EMS 1%’er is not just a title—it’s a responsibility. These professionals are on the front lines of quality, reviewing thousands of patient care reports each year to ensure that EMS systems nationwide don’t just meet the standard—but exceed it.
“The audit is the first step in helping each provider be the best they can be,” says Girard. “And the EMS 1%’ers are the tip of the spear. They’re making EMS safer, smarter, and stronger—one call, one chart, one conversation at a time.”
If your EMS agency wants to move beyond minimal compliance and build a culture of continuous improvement, The G&A Way begins with the audit. And the audit begins with the EMS 1%’ers.
By Kevin Kelley and Paul Girard
About Girard & Associates
Girard & Associates, Inc. is a national EMS Continuous Quality Improvement (CQI) firm based in Westport, MA. With over 40 professionals across the country, G&A specializes in EMS documentation review, provider coaching, CQI program development, and risk reduction. Founded in 2005 by Paul Girard, the firm has conducted over half a million chart reviews and one-on-one feedback sessions for agencies of all types and sizes.
To learn more, visit www.girardassoc.com or contact Paul Girard at paul.girard@girardassoc.com or by phone at 1-877-374-6811.
Related articles:
The 4C’s Of EMS CQI Leadership
EMS Quality Control – “Who Needs It And Why Do It?”
